1811331812 NPI number — JOSEPHINE FRANCES DENNISON PA-C

Table of content: JOSEPHINE FRANCES DENNISON PA-C (NPI 1811331812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811331812 NPI number — JOSEPHINE FRANCES DENNISON PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DENNISON
Provider First Name:
JOSEPHINE
Provider Middle Name:
FRANCES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DENNISON
Provider Other First Name:
JOYCE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1811331812
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4638 S WHITE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLETON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80127-1111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-972-4504
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3333 REGIS BLVD F-12
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80221-1099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-458-3558
Provider Business Practice Location Address Fax Number:
303-964-5406
Provider Enumeration Date:
04/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  1651 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1651 . This is a "STATE OF COLORADO" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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